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In This Issue of JAMA Facial Plastic Surgery
Sept/Oct 2016


JAMA Facial Plast Surg. 2016;18(5):323. doi:10.1001/jamafacial.2015.1236

Patel and colleagues report on a multi-institutional cohort study that describes the frequency and predictors of complications in patients undergoing delayed facial reconstruction after Mohs micrographic surgery. A total of 415 cases in 342 patients were identified. Reconstruction occurred from 1 to 11 days after excision, with 95.4% of repairs occurring within 2 days of MMS. The overall complication rate was 8.2%. They noted a statistically significant increased risk of complications with composite defects, or if an interpolated flap with cartilage was performed, or if reconstruction was performed after more than 2 days.

Goines and coinvestigators compare observers’ perceptions of disability and quality of life among people with facial paralysis based on patient images with the patients’ own assessments. This prospective study in an academic tertiary referral center included 84 naive observers who viewed static and dynamic images of faces with unilateral, House-Brackmann grades IV to VI facial paralysis and demographically matched images of nonparalyzed control individuals. Observers were more likely to rate quality of life lower owing to disability than were the patients with paralysis. The authors conclude that the dissonance between observers and patients in this area has important implications for the socialization of patients with facial paralysis.

Kochhar and coinvestigators conducted a retrospective study of 20 patients with facial paralysis who underwent mobilization and transposition of the intratemporal segment of the facial nerve for an end-to-side coaptation to the hypoglossal nerve. Outcome measures include paralysis duration, facial tone, facial symmetry at rest, and with smile, oral commissure excursion, post-reanimation volitional smile, and synkinesis. They found that mobilization of the intratemporal segment of the facial nerve provided adequate length for direct end-to-end coaptation and was effective in restoring facial tone and symmetry. The resulting smile was symmetric or nearly symmetric in most patients with varying degree of dental show. The additional length provided by using the intratemporal segment of the facial nerve reduced the deficits associated with complete hypoglossal division and/or splitting, and avoided the need for interposition grafts and multiple coaptation sites.

Kiyohara and colleagues performed a systematic review of available over-the-counter nasal dilators designed to relieve nasal obstruction. A database of 33 mechanical nasal dilators was generated. Efficacy was based on objective measures, such as measured airflow, the cross-sectional area of the nasal valve, and changes in resistance. Five studies supported the use of external nasal dilator strips, 4 studies supported the use of nasal clips, 1 study supported the use of nasal stents, and no studies supported the use of septal stimulators.

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